TUMOR,NEOPLASM Pathology Department, Zhejiang University School of Medicine, 马丽琴,maliqin198@zju.edu.cn
The points in this chapter What is a neoplasm (conception) Morphology of neoplasm Macroscopy of Neoplasm Histology of Neoplasm Atypia of Neoplasm Growth and Spread of Neoplasm
epithelial:adenoma, papilloma benign Mesenchymal: lipoma, leiomyoma neoplasm malignant epithelial(carcinoma) mesenchymal(sarcoma) Hematopoietic and lymphoid system(lymphoma, leukemia) others:immature teratoma, malignant melanoma, carcinosarcoma
Neoplasm was an ancient disease and rare in remote Ages Neoplasm could be suffered in human, animal and botany
The most common cancer in our country: gastric carcinoma, hepatic carcinoma, pulmonary carcinoma, esophageal carcinoma colorectal carcinoma leukemia & lymphoma cervical carcinoma breast carcinoma
Morphology of Neoplasia Gross appearances Please pay attention to following key words: Shape Size Number Color Consistency
Shape :varied Local thickness Polyp-like Papillary Nodular Tree-root Ulcer-like Cyst-like Volcano-mouth Crab-like
Nodular
Cyst-like
Ulcer-like
Polyp-like
Papillary
Size Could a neoplasm in small size trend more to be benign? Could a neoplasm in large size trend more to be malignant? Squamous cell carcinoma Femur Osteosarcoma
Ovarian mucinous cystadenoma
multiple primary tumor Uterus leiomyoma multiple Cylindroma in sweat gland
Color Generally speaking, the color of a neoplasia comes from its originated tissue. Benign tumor: similar to its original normal tissues Malignant tumor: fish-flesh, gray-white, gray-yellow,brown and so on
Benign or malignant? Lipoma with yellowish color from fat tissue
Benign or malignant? Pulmonary carcinoma
renal carcinoma
Color melanoma Black color
Consistency It quite depends on neoplasia s originated tissue. (1). its type:osteoma hard lipoma --soft (2). proportion of parenchyma to stroma: (3). consequent lesions: cystoid,necrosis softening calcification hard
Histology of Neoplasm Microscopy: Parenchyma = tumor cells (decide its biological behavior) Stroma = connective tissue + blood vessels to provide mechanical support and nutrition to the neoplastic cells.
Parenchyma Stroma Stroma squamous carcinoma
stroma parenchyma Adenocarcinoma
Atypia of Neoplasm Please attention to four words usually encountered: Atypia( 异型性 ), Differentiation( 分化 ), Dysplasia( 异常增生 ), Anaplasia( 退行性 ) 1. Atypia The noun refers to their difference between neoplasia and their normal forebears, both morphologically and functionally. a. pleomorphism ( 多形性 ) b. disorderliness ( 紊乱 )
Atypia of Neoplasm Cell Features of cells: nuclear-cytoplasmic ratio=1:4-6 polarity size and shape chromatin Pathological mitosis Features of tissue Structure of tissue Polarity of tissue
Ratio of Nucleus / Cytoplasm Normal cell Tumor cell
pleomorphism
Cellular pleomorphism with abnormal mitosis
Pathological mitosis
Atypia of Neoplasm tissue abnormal structure and arrangement loss of polarity variation in size and shape invasive growth
Normal Well-differentiated Mild differentiated Poorly-differentiated
Differentiation The noun refers to the extent to which they (neoplasia cells) resemble their normal forbears, both morphologically and functionally.
Benign tumor Normal tissue malignant tumor
Growth and Spread of Neoplasm
Biology of growth Growth pattern and spread of tumor Mechanisms of local and distant spread in malignant tumors
Growth pattern and spread of tumor Growth rate benign tumor slow malignant tumor fast
Growth pattern 1. Expansive growth (often benign) 2. Infiltrating growth (often malignant) 3. Exophytic growth (both)
Expansive growth
Expansive growth
Invasive growth
Invasive growth
Invasive growth
Exophytic growth
Exophytic growth
Spread of Neoplasia Including direct spread and metastasis 1. direct spread Malignant tumor cells spreading basement membrane interstitial space lymphatic vessels blood vessels Direct and local spread in cervical carcinoma
Three Pathways of Metastasis Lymphatic metastasis Hematogenous metastasis Planting of the transfer
Merging of Lymph nodes
Metastatic adenocarcinoma in lymph node
Hematogeneous metastasis Tumor cells systemic veins lung portal veins liver pulmonary veins all over the body( brain, bone, kidney, adrenal gland, et, al.)
Multiple and scattering, marginal location, round,
Liver metastatic carcinoma
spleen metastatic carcinoma
Brain metastatic carcinoma
osseous metastatic carcinoma pathological fracture
Implantation metastasis Seeding in body cavity and surface. common sites: pericardial, pleural and peritoneal cavities results in an effusion of fluid into the cavity,to accompany adherence / fluidify The fluid: rich in protein and may contain the neoplastic cells cytological examination : important in diagnosing the cause of effusions into body cavities.
Implantation metastasis
Implantation metastasis
Krukenberg tumors
Implantation metastasis, Ascites
Grading and staging of neoplasia
Grading and staging of neoplasia Grading cytologic differentiation the number of mitoses grade Ⅰ: well-differentiated ( low potential malignancy) grade Ⅱ : moderately differrentiated (medium potential malignancy ) grade Ⅲ : poorly-differentiated (height potential malignancy ) Undifferrentiated
well-differentiated adenocarcinoma
well-differentiated SqCa